Provider Demographics
NPI:1386971406
Name:C&C ORTHO PC
Entity type:Organization
Organization Name:C&C ORTHO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-488-8889
Mailing Address - Street 1:3916 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3602
Mailing Address - Country:US
Mailing Address - Phone:918-488-8889
Mailing Address - Fax:
Practice Address - Street 1:3916 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3602
Practice Address - Country:US
Practice Address - Phone:918-488-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51521223X0400X
OK49191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1447478698OtherINDIVIDUAL NPI #: 1447478698 - BRENDA CHOCKLEY, DDS
OK1447478698OtherINDIVIDUAL NPI: 1104041920 - JONATHAN COOPER, DDS